Liberty University Athletics Department Hall of Fame Nomination Form Nominee’s General Information Name of Nominee: ________________________________________________________________________________________ Circle One: Student‐Athlete | Coach | Athletics Administrator | Athletics Contributor Nominee’s Current Contact Information: Current Address: _______________________________________________________________________________________ _______________________________________________________________________________________ Phone Number: (____) ____________________ Email: ____________________________________________________________ Nominee’s Athletic Information: Year(s) of Competition at Liberty: ____________________________________________________________ (example: 1993‐96) Sport(s) Nominee Played: ____________________________________________________________________________ Major(s) at Liberty: ____________________________________________________________________________ Please list any collegiate accomplishments to support this nomination: (Example: Academic honors, athletics honors, program and conference records, team accomplishments during his/her span with the program, etc.) Please list any post‐collegiate competition opportunities or achievements to support this nomination: (Example: professional/Olympic competition, significant contributions to his/her sport, excellence in his/her professional vocational career, etc.) Other pertinent information to support this nomination: (Note: Please use this area to provide supporting information for Administrator/Athletics Contributor nominations, plus any other relevant information for this student‐athlete or coach nominations) Nominator’s Contact Information: Name of Nominator: ________________________________________________________________________________________ Affiliation with Liberty (Alumnus, employee, Flames Club member, friend, etc.) _______________ (If alumnus, please provide year) Address: __________________________________________________________________________________________________ Phone: ( ___ ) _________________________________ Email: ______________________________________________________ Please return this form to Kevin Keys, chair of Liberty’s Athletics Hall of Fame committee: Address: Kevin Keys, Associate Athletics Director, Liberty University, 1971 University Blvd., Lynchburg, VA 24502 Email: [email protected] – Fax: (434) 582‐2076 Nomination Notes: ‐ To be eligible for the Liberty Athletics Hall of Fames, a student‐athlete must be five years removed from competition. ‐ Nominations will be accepted throughout the year and will be evaluated prior to the selection of each year’s Hall of Fame class. ‐ You may include up to one additional page of supporting information, if necessary.